Got FAQs?

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By Lisa Lake-Salmon

There are a lot of great reasons to pay attention to reimbursement practices. The provider that manages reimbursement poorly is slow to get paid and may even violate Medicares rules and regulations without knowing it. Count on "Got FAQs?" to keep you informed as you prepare for O&P in 2007 and beyond.

Q: I read that there were some new L-Codes for obese patients who require prosthetics. Are you familiar with these codes? How would I bill them to Medicare?

A: Effective January 1, 2007, DMERC added two codes that should be used for patients whose weight is greater than 300 lb. L-5993 (addition to lower-extremity prosthesis, heavy duty feature, foot only) and L-5994 (addition to lower-extremity prosthetics, heavy duty feature, knee only). When using these codes, you must put the patient's weight in the additional documentation field of your claim.

Q: I am a new provider in the state of Pennsylvania. I have searched for the Pennsylvania Medicaid website, and I am unable to locate it. I was told I could verify patients' insurance coverage on this site and would like to be able to use it. Are you familiar with this site?

A: Pennsylvania Medicaid's website can be found at . Also known as the Promise System, you can use this site for multiple billing tasks. The system provides real-time response, and you can verify patient benefits, claim status, retrieve remittance notices, and more.

Q: A fellow practitioner and I have been debating over whether or not it is okay for us to write off the 20 percent co-pay if the patient cannot afford to pay. Can you tell us the correct way to handle this situation?

A: The law requires the provider to make an effort to collect the 20 percent co-insurance payment. The supplier must keep evidence of the attempt to collect the co-insurance payment from either the patient or the secondary insurance on file. The supplier has an option of waiving the co-insurance in case of hardship; however, a supplier cannot routinely waive the 20 percent co-insurance payment for every patient.

We invite readers to write in and ask any questions they may have regarding billing, collections, or related subjects. For more information, contact

Lisa Lake-Salmon is the executive vice president of Acc-Q-Data, which provides billing, collections, and practice management software and has been serving the O&P industry for more than a decade.